Low-income Women Now Get Aid For Treatment-not Just Screening-of Breast Cancer

November 29, 2000|By Barbara Brotman, Tribune Staff Writer.

Last March, Elaine Thomas, 50, of North Chicago, found a lump in her breast.

A raging lump, growing almost daily beneath her fingers. Within weeks, it was visibly protruding from her skin.

It turned out to be breast cancer so aggressive that chemotherapy could barely shrink it. When she had a radical mastectomy in August after nearly five months of chemotherapy, the main tumor was the size of a small grapefruit, and it had spread to four of her six lymph nodes.

But when she was awakened at night by recurring nightmares, it wasn't the cancer she was dreaming about; it was the bills.

"It was the same dream, night after night," she said. "I would get the bill and put it in a desk drawer. And the drawer kept slowly sliding open because the bill was growing. Eventually, the bill was chasing me around the room, trying to kill me."

Thomas was uninsured. Her mammogram was covered through the Breast and Cervical Cancer Screening Program, which provides no-cost mammograms and Pap smears to low-income women in Illinois. It is part of a national early detection program that for 10 years has served women who are not covered by Medicaid or private health insurance.

But once Thomas was diagnosed with cancer, she found a gaping hole in this safety net: While her screening was covered, there was no similar program to pay for the treatment.

There is now. The Breast and Cervical Cancer Treatment Act of 2000, passed by Congress with bipartisan support and signed by President Clinton last month, will allow women who have been diagnosed under the screening program to be treated under Medicaid, using a combination of federal and state funds.

"There was a glaring inequity," said Lt. Gov. Corinne Wood, a breast cancer survivor who lobbied on behalf of the new act. "Imagine being told you have cancer, and then told, `I'm sorry, we don't know where you should go [for treatment].' I can't imagine the personal angst."

In Illinois, the screening program has diagnosed 133 cases of breast cancer and 9 of cervical cancer in the last five years. Nationwide, the program has found nearly 6,000 cases of breast cancer, and more than 500 cases of cervical cancer, since its inception in 1990.

In order to be eligible for the screening, and thus the treatment program, women must have incomes under 200 percent of the federal poverty level. The cutoff for a woman in a family of four would be $34,000.

Many of the women in the program work at jobs that don't offer health insurance but pay so little that the women can't afford to buy their own.

"Most of our clients are the working poor, the women who work in fast food and the service industry," said Conny Moody, chief of Women's Health Services in the state's Office of Women's Health, and project director of Illinois' screening program.

Thomas was going to school and working part-time and temporary jobs before her illness. She stopped paying about $300 a month for private health insurance about five years ago, when she was struggling to pay college tuition for herself and her two children. All three recently graduated from Columbia College in Chicago; the family had hopes of starting its own children's show production company.

To help women like Thomas before the new act was passed, the screening program "begged, borrowed and stole," said Wood, who has been instrumental in lobbying for both the screening and treatment programs.

"Some of it is actual physicians writing it off; some is hospitals writing it off," said Ruth Todd, case management coordinator for the Breast and Cervical Cancer Screening Program with the DuPage County Health Department. "It's been wonderful that they have been willing to do that."

Thomas spent four months trying to get approved for Medicaid. Her friend Shelley Hoselton became her tireless advocate, making countless phone calls to doctors and government offices. Staffers with the Lake County screening program spent hours waiting with Thomas in a local Human Services Department office. Thomas visited the office repeatedly, once lowering her blouse in desperation to show the female case manager the clearly visible lump.

The Department of Human Services twice denied her application on the grounds that she did not meet the Medicaid requirement of being disabled. After her doctors submitted additional documentation, her application was approved.

"It was jumping through one hoop after another," said Hoselton, who runs a Libertyville talent agency and dance school where Thomas directed a children's troupe before her illness.

"It was definitely longer than usual," said Ken Walker, regional administrator for the Illinois Department of Human Services.

Ninety-seven percent of cases handled by Thomas' local office are disposed of within 60 days, he said. What held up Thomas' application, he said, was that it took several exchanges with her doctors to establish that she was disabled.